Screw and Cervical Collar in the Cervical X-Ray???

Yesterday Morning, We were shown a few radiograph by the ENT specialist. There was this particular radiograph/X-ray which we were shown and asked to comment on it. It was an X-ray with minor opacities over the tooth, 2 small opacities on the anterior and posterior atlas with typical linear like pattern on the lower neck.

The tooth part? O f course we all know that it's actually a dental filling. However, no one could really answer on the opaques linear thing on the lower neck until the very end moment where someone suddenly shouted "" Cervical collar" !! and the two opacities? Someone answered screw but no one could actually answer what screw is that used in the orthopaedic.
Well, i think some of us actually noticed what it was until we were convinced that it's maybe a cervical collar. What a funny laugh....


In the end?


Neck -----> Necklace

Atlas there? ----> earrings


What a tricky thing to show us....


And the lessons?


To all radiologist. please remove patient's jewellery before any radiograph is to be taken orelse it will be mistaken by the medical student as "screws" and cervical collar!!!!!

Rinne, Weber and Absolute Bone Conduction Test

1) Rinne Test -->
After vibrating it, it's put in front of the patient's ears to checked if patient can actually hear the ringing sound. Best if you hear it by yourself first to make sure its a good vibration.
Then put it behind the patient ear just above the tip of the mastoid process. Asked the patient if he/ she is hearing the sounds(not feeling the vibration)and instruct sher to inform once she can't hear. Then, the tuning fork should be shifted in front of the patient ear to check if she still hear anything.Test the other side of the ear as well. Positive Rinne test will mean air conduction which is usually better than bone conduction.

2) Weber Test-->
Again,vibrate the tuning fork using the same way that you're comfortable with before it's put on the center of the patient's forehead/chin(better on the forehead). Ask the patient whether he can hear the sound before you proceed asking whether he can appreciate whether both side of the ears hear equally or 1 side of the ear is hearing better.

If the test Lateralise, or patient hears better on one side of the ear, it means he has either sensorineural hearing loss on the opposite ear or he has conductive deafness of the same side. This should however be confirmed with Absolute Bone Conduction test (ABC)


3) Absolute Bone Conduction test -->

This test is done in the assumption that the examiner actually having both normal conductive and seusorineural hearing ability.

The vibrating tuning fork is placed on the mastoid process again with the tragus of the ear pressed to occlude the external ear meatus (obstruct air conduction).The patient will hear if he has a normal sensorineural conduction of hearing.

Gosh!!! I am having Left sided sensorineural hearing loss???

I was in the clinic with a ENT specialist and was requested to examine the patient hearing ability. Basically, i have to show how i carried out Rinne Test, Weber Test and Absolute Bone Conduction Test using 512 Hz tuning fork.

Tuning fork was tuned either by using the index finger and thumb or by hitting it on the tip of elbow/elecranon.

1) Rinne Test -->
After vibrating it, it's put in front of the patient's ears to checked if patient can actually hear the ringing sound. Best if you hear it by yourself first to make sure its a good vibration.
Then put it behind the patient ear just above the tip of the mastoid process. Asked the patient if he/ she is hearing the sounds(not feeling the vibration)and instruct sher to inform once she can't hear. Then, the tuning fork should be shifted in front of the patient ear to check if she still hear anything.Test the other side of the ear as well. Positive Rinne test will mean air conduction which is usually better than bone conduction.

2) Weber Test-->
Again,vibrate the tuning fork using the same way that you're comfortable with before it's put on the center of the patient's forehead/chin(better on the forehead). Ask the patient whether he can hear the sound before you proceed asking whether he can appreciate whether both side of the ears hear equally or 1 side of the ear is hearing better.

If the test Lateralise, or patient hears better on one side of the ear, it means he has either sensorineural hearing loss on the opposite ear or he has conductive deafness of the same side. This should however be confirmed with Absolute Bone Conduction test (ABC)


3) Absolute Bone Conduction test -->

This test is done in the assumption that the examiner actually having both normal conductive and seusorineural hearing ability.

The vibrating tuning fork is placed on the mastoid process again with the tragus of the ear pressed to occlude the external ear meatus (obstruct air conduction).The patient will hear if he has a normal sensorineural conduction of hearing.


This is the part i screwed up where the patient can hear with the absolute bone conduction test and i couldn't on the left side. Goshh...so? i am having some sensorineural hearing loss? The ENT specialist tested me again and it's sound like my ear is having some problem. I was send for Pure Tone Audiometri and the test comes out to be normal surprisingly enough...Hmm...so, what's wrong with me? I myself just can't figure it out...